Bishop John Shelby Spong, RIP

I was saddened to learn today of the death of John Shelby Spong, Bishop Emeritus of the Newark, New Jersey diocese of the Episcopalian Church. Though I can’t claim to have known Bishop Spong very well, he was a close friend of my parents’, and a constant presence in our family home. He was for decades Chairman of the Board of Trustees of Christ Hospital in Jersey City, where both of my parents worked–my father for forty, and my mother for thirty years. So we knew Bishop Spong less as a bishop than as a hospital trustee. The stories–or legends–I heard about him for decades were about health care, not theology.

Spong speaking in England; photo credit: David Gibson/RNS

Christ Hospital started its life as an Episcopalian institution. It later merged (or attempted to merge) with St Francis Hospital across the city, a Catholic institution. The merger initiated an apocalyptic sectarian battle for the mortal souls of both hospitals, a battle in which (I’m told) Bishop Spong did a fair bit of the fighting. Eventually, after a series of Jesuit-worthy legal complications I’ve never been able to grasp, Christ Hospital was consumed by the godless and soulless CarePoint Health System. By then, Bishop Spong had had the good sense to leave the hospital behind; Jesus Christ may or may not have been resurrected, depending on your theology, but Christ Hospital was not going to be resurrected, at least not in the form it originally took as an urban community hospital in the Episcopalian tradition.

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New blogger: Suleman Khawaja

I wanted to welcome a new blogger to Policy of Truth, my brother, Suleman Khawaja. Suleman is currently a hospitalist at Valley Hospital in Ridgewood, New Jersey, where (in Ridgewood, not at Valley) he also runs a private practice as an expert witness on a variety of medico-legal issues. He received his BA in Political Science (minoring in Philosophy) at Duke University, and got his MD at the Pritzker School of Medicine at the University of Chicago. He did his residency in Internal Medicine at UNC Medical Center in Chapel Hill, North Carolina. By a strange coincidence, both Suleman and I studied extensively with Alasdair MacIntyre–as a graduate student at Notre Dame in my case, and as an undergraduate at Duke in his.

Suleman will be blogging here primarily on health care issues, with a particular focus on the COVID-19 pandemic.

The Waiting Is the Hardest Part: Booster Shots Revisited

So here is the report from The New York Times we all could have guessed we’d find ourselves reading one of these mornings.

While it is premature to conclude that the pause and retrenchment on government approval of booster vaccines will prove to be a permanent one, I’d be remiss if I didn’t point out the following:

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Who Made WHO: COVID-19, Global Class Warfare, and Booster Shots

Who pick up the bill when who made who? Ain’t nobody told you?

–AC/DC

On August 18th, The New York Times ran a story on the front of its feed titled “Booster Shots ‘Make a Mockery of Vaccine Equity,’ the WHO’s Africa director says.” In case that statement sounds needlessly inflammatory and emotionally manipulative, here’s the actual quote from Dr. Matshidiso Moeti:

Moves by some countries globally to introduce booster shots threaten the promise of a brighter tomorrow for Africa. As some richer countries hoard vaccines, they make a mockery of vaccine equity.

To say that the introduction of a booster program in one nation poses a near-existential threat to a continent of 1.2 billion people is a stretch. But it’s not until you drill down to the factual details of the worldwide dynamic of COVID prevalence, vaccine production, and actual vaccination that you get a sense of how misleading and irresponsible that statement is, and how shaky is Moeti’s subsequent claim that as a consequence of boosters, more dangerous variants of COVID will arise.

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The JBMDL Afghan Account

I was sitting in my cubicle mid-day when an email with an odd subject line tumbled into my inbox: “JBMDL Afghan.” It was from a bona fide sender, so I opened it and took a look. It turned out to be an email from the director of financial services at a major hospital system, making reference to a new medical services “payor,” as we spell it in the trade. It was, in other words, the Joint Base McGuire Fort Dix Lakehurst Afghan payor, i.e., the payor of medical services for Afghan refugees housed at McGuire Air Force Base/Fort Dix Army facility in Lakehurst, New Jersey. Otherwise known as the US military.

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Cancel Culture: A Recantation

In previous posts here, I’ve argued that “cancel culture” is fake news–an ideological confabulation devised by the Right to discredit the Left, which is usually “credited” with having created it. I now realize that I’ve been deeply wrong, and wish to recant. Cancel culture certainly does exist, just not in the way its usual ideological adversaries would have you believe.

Think of any event that requires scheduling, e.g., an appointment, a work schedule, business hours, a conference, a travel itinerary, a date. Think of how ubiquitous such events are, and how complex and expensive the infrastructure required to keep them going–to keep the slots filled, to keep the workflow efficient, to make sure everything runs on time. Consider how much reliance the various parties place on the others in the scheduling process. If A schedules with B, A relies on B to be there, and B relies on A to show up. If A doesn’t show up, the failure (whether culpable or not) adversely affects both B and any third parties who would have used A’s slot but couldn’t, given A’s (let’s say) sudden absence. If B doesn’t show up, the absence affects A as well as a set of third parties.

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COVID Booster Shot Meets Health Care Monopoly

This post is part of an occasional series on health care. Here’s the prologue to the series, which originally preceded the post below.

Here’s a fairly straightforward story from The New York Times from a few days back, reminding us of the fact that immunity from some of the COVID vaccinations is limited in time, and may well require a booster shot.

 WASHINGTON — Biden administration health officials increasingly think that vulnerable populations will need booster shots even as research continues into how long the coronavirus vaccines remain effective.

Senior officials now say they expect that people who are 65 and older or who have  compromised immune systems will most likely need a third shot from Pfizer-BioNTech or Moderna, two vaccines based on the same technology that have been used to inoculate the vast majority of Americans thus far. That is a sharp shift from just a few weeks ago, when the administration said it thought there was not enough evidence to back boosters yet.

On Thursday, a key official at the Centers for Disease Control and Prevention said  the agency is exploring options to give patients with compromised immune   systems third doses even before regulators broaden the emergency use authorization for coronavirus vaccines, a step that could come soon for the Pfizer    vaccine.

Skipping a bit:

Pfizer’s continuing global study of its clinical trial participants shows that four to six months after the second dose, the vaccine’s effectiveness against symptomatic infection drops from a high of 95 percent to 84 percent, according to the company.

As a (then) full-time hospital worker actively exposed to high concentrations of COVID, I got my second dose of the Pfizer-BioNTech shot on January 6. If the vaccine’s effectiveness definitely drops from 95% to 84% in four to six months, then I’m well past my due date for a booster. Though I’m no longer a full-time hospital worker, I’ve been waiting for twelve weeks now for the paperwork to go through on my bid to work per diem for Hunterdon Medical Center’s OR. Assuming it goes through, I’ll be back in the COVID-intensive environment I previously inhabited. And if it doesn’t go through, I intend to apply to do the same work at a different hospital. So one way or another, I intend to make my way back to hospital work, and (by implication) to re-immerse myself in COVID.

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Health Care: A Series

This was originally a post on COVID booster shots, but I’ve now broken it into two separate posts, the first a prologue offering a very general summary of my approach to issues in health care, and the second, a post expressing skepticism about the need to wait any longer before we roll out a COVID booster, as well as skepticism about monopolistic institutional arrangements (distributive and/or regulatory) in health care.

I work in health care, but have no worked-out view on the political economy of health care. In fact, part of the reason I accepted the (full time) job I currently have, in hospital revenue cycle management, is to clarify my thoughts on that very subject. So I’m open to being schooled on issues in health care by anyone willing and able to do so–a category that probably includes a very large number of people. For the time being, I’m willing to remain at least temporarily in a state of curmudgeonly skepticism, willing to take pot shots at almost everyone, but unwilling to pledge allegiance to much of anything. You might regard that as a frivolous position to take, considering the stakes involved. But I don’t.

Since I’m going to be writing here at PoT about health care a fair bit in the near future (I’ve done some already), take what I say in the preceding skeptical (or dialectical) spirit. My aim is, through discussion and experience, to work my way from skepticism to something more definite.

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